What's my therapeutic approach then?

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aving just read an article about therapeutic relationships in the outdoors, I wanted to try to write down the way I work as a therapist. Every therapist works in a different way, even those who are trained in the same theoretical approach. So, two cognitive behavioural therapists will still have subtle different ways of working, even though they are both trained in the same approach. This is why I think it is so important to meet a few therapists before choosing the one that you want to work with: they might all advertise similar things, but they will all feel different when you meet them.

I was trained as a Person-Centred therapist. This means that I work with people in a non-directive way (i.e. I don't set out with an agenda of what we should look at in sessions) as I believe that people themselves know intrinsically what they need to work on in order to move forward; we are experts in our own lives, not on each others lives'. This may sound all wrong, and I can hear people saying "If I knew how to sort out my problems, I wouldn't be coming to see you!". However, all those important experiences and feelings are within you, it is just a matter of understanding what those experiences and feelings mean for you. Therapy is a place to do that work.

So, I don't set an agenda in therapy: you decide what you want to look into in our therapy sessions. What else do I do? Carl Rogers, who started Person-Centred therapy in the 1950s, said that there had to be 6 conditions present in therapy for it to be effective (Rogers, 1957). I will now attempt to explain these in my own words!

1. The therapist and client have to have some sort of connection. People speak about having chemistry between them, and that sums up this first factor in a basic way. Hence, if you don't feel chemistry between you and your therapist, you might be off to a bad start.
2. The client is coming to therapy with some sort of emotional difficulty, such as anxiety, low mood, hearing voices, anger, etc.
3. The therapist will try to be honest in the relationship ("congruent" is the word that Roger's used).
4. The therapist tries not to judge the client and what the client talks about. This is so important. We live surrounded by people making judgements about us all the time, and this can lead to problems for the person being judged.
5. The therapist tries to empathise (not sympathise) with where the client is at, and to see how life looks through the client's eyes. This is very different to imagining what that same experience would have been like through my eyes. So, just because the client and therapist have both experienced the death of their mother, this does not mean that the therapist will have experienced it in the same way as the client. The therapist also needs to communicate this empathy to the client, usually through talking.
6. The client has to be able to understand the therapist's feedback and experience of them. 

Roger's stated that when these six factors were present in a therapeutic relationship, healing could take place. We need other people to help us to grow as people because we are social animals, like chimpanzees. However, some relationships that we have can cause harm rather than growth. Therapy is the opportunity to have a new and fresh relationship which is aimed at helping you to work through your difficulties, not about trying to make you fit how others think you should be.

There are other things which go on in therapy. Here are a few:

• People may have had a lack of boundaries growing up, and so therapy maybe all about hitting those boundaries in the therapist, and then being able to explore what that's like in therapy - i.e. in a safe space.
• Some people may keep repeating the same behaviour/reactions in certain situations, such as relationships, which causes them harm. Therapy is a chance to look at those behaviours/reactions from a different point of view and in a safe environment. 
• Therapy is also the chance to experience a different kind of relationship. We may expect to get the same reactions from other people about what we are like, and so we in turn respond in the same way. Within the therapeutic relationship we can get a different reaction, and a space to explore what that is like. 
• And some people simply want a place to off-load their baggage. They have been carrying it for years, and it is almost getting too heavy for them to carry. Sharing that baggage with a therapist can lighten the load so life feels...lighter.

I also work outdoors with people. Why do I do that? Well, I find it hard to put this into words, but I'll try! We are part of Nature, as oak trees, roe deer, and bacteria are. But, modern, industrial life has driven us away from Nature, and I believe this split has caused us issues. So, alongside the above reasons why therapy helps people, I think that allowing people to work outdoors can help people to reconnect with nature. Here's my attempt at a metaphorical explanation! It might be bit like keeping a dog in a cage, indoors, for years. Due to it's nature, it wants to get outside, and run around, and meet other dogs, and smell the ground. It is quite an aggressive and frustrated dog, and has periods of being quite subdued. And then it goes to a new home where the owner takes it for walks throughout the day, and it meets other dogs, and even has the chance to run free at times. It becomes less anxious and aggressive, and has less periods of being subdued. This is very simplistic, but does give a flavour of what I think urbanisation has done to us. We are more frustrated, more aggressive, more unhappy. Getting outside can be the thing which changes this. It allows us to express those parts of us which cannot be expressed in cities and towns.

If you have any questions about therapy, or the way in which I work, then please post your question below or email me. 

References

Rogers, C (1957): The Necessary and Sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, Vol. 21, pp. 95–103

The Sound of Spring

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ell Spring is here, albeit in a damp, windy, hot and cold way. Whilst I may find the weather hard to keep up with - having got soaked through and very cold the week before last, and then wearing too many clothes last week - I find the wildlife comes alive from the end of winter through to spring. Last Monday I heard the Cuckoo for the first time this year...

...and the swallows also started to circle our house last week. They are animals that always make me happy as they chatter and swoop about. I find it odd that hearing and seeing another animal can affect my mood. But having just written that, it seems perfectly feasible. I think the way in which they speed around so close to the ground is exhilarating to watch. And at the risk of anthropomorphising, they do look like they're having fun!

The curlews arrived a day later than last year, on 4/3/15. Well, they arrived on 3/3/14 last year, so maybe for the Curlews it was the same day as I imagine that they don't follow the Gregorian calendar!

Other sounds this spring have been the increasing noise of the Roe Bucks as they head towards the rut in July/August. Rather than there actually being an increase of the deer barking in our area, I think that I have become more familiar with the sounds that they make, and I am able to discern a roe bark over that of a common dog barking, which I ignore much of the time. The mother of last year's male and female appears to be pregnant; she gave birth around the middle of June last year. Roe Does have a unique ability: while they mate with a buck in late summer, the fertilised egg does not start to grow until December. This is called embryonic diapause. They then give birth around May/June. 

I have found that since moving out of the city and into a rural area, I have become more and more aware of the natural sounds of life around me. With the passing of each year, I feel that I am becoming more attuned, or maybe more in-tune, with the natural world around me. This is in direct contrast to life in the city, where I found that I had gotten used to blocking out sounds, not becoming attuned to them. Friends would come and stay and mention the noise of the Heathrow flight-path overhead, and it would take me a moment to become aware of it. I had become desensitised to it. I find it interesting, then, to notice that I seem to be letting in more natural noise in the countryside, while in the city I was blocking out the urban noises. I can expand outdoors, while I seem to contract in the city.

Do humans work like cars?

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ver the past couple of weeks I have been doing a fair bit of maintenance work on my Landrover Defender. It is very satisfying, but also very frustrating as I don't have the knowledge nor experience to sort problems out quickly and efficiently. But I am learning, and Youtube is a great help.

Being a psychotherapist, this led me to thinking about the similarities between humans and cars. Cars work in a relatively simple way. Once you can understand how the system works, it will be the same whether you look at the car again tomorrow morning, or in ten years time. It is mechanical. I can look at the rear-axle, see that it is attached to a rear-differential, look at the prop-shaft coming out of that, follow it forwards to the transmission, gear box, engine, and so on. One thing follows another. There are no massive variations, and I can track through the car to find what part is connected to or linked to another part. I would like to think that humans work in a similar way, but I am not convinced of this.

We are a body, with various organs (heart, lungs, liver, feet) just as a car has various parts (fuel pump and injector, air filter, oil filter, rear wheels). The brain is also just another organ. But we do seem to see this as a special organ. It has been named (by someone I can't remember!) as the "seat of consciousness". Which leads me to this thing called consciousness. It is not something I can touch, pick-up, nor examine with my eyes, unlike an exhaust system. It appears to be ethereal, and not made-up of matter. However, it must be made-up of physical processes. If a car's movement is the product of the engine and working parts collaborating together to produce forward movement, so a human body and all - and I mean all - its organs collaborate to produce conscious awareness.

So, on the surface of it, we are just like cars. More complex maybe, but still a series of physical processes within a physical body producing us. Consciousness or 'who we are' can be reduced to 'simple' physical states.

But, where the analogy gets more opaque is when I look at how I came to be who I am today. I am not the same as my wife, nor neighbour, nor any other human on the planet (I think!). I am Me. I am a product of both my physical body (which has been affected by my genes and my environment) and my life experiences. I fell on some stone steps as a child and I still have the scar on my forehead. I had surgery on my knee ten years ago due to rock climbing and a weakness in my cartilage, and so have difficulty with my knee at times. I was given a healthy, balanced diet as my body grew, and so I am taller than my predicted height was. In fact, if I had been born and brought up in a third-world country I probably would not be the height I am now regardless of my genes. But I have also been shaped by my life experiences in an emotional way. I don't enjoy being in large groups of people, but why? Maybe because I was brought up as a semi-only child with my brothers being significantly older than me. Maybe because I'm just over-sensitive to how others perceive me: when there are more people in a room, there are more perceptions to deal with, and so this is a more stressful environment. But why the hell am I even struggling to work this out? Fuel gets to the engine cylinders via the fuel tank, pump, filter and then fuel injectors. Blood gets to my muscles via a series of electrical impulses sent from my brain to my heart, which then pumps the blood to my legs via a series of arteries and capillaries. Yet the path of how my personality has been shaped is far more complex. It feels significantly harder to simply trace back through the past to find the important parts. There are so many more variables to take into account - genes, family environment, school, friendships, significant events, and so on.

So how does this apply to therapy? People's personalities are like a confused ball of wool, and therapy feels like a process of pulling out random strands, looking to see if they are connected to the current issue; maybe putting them aside to look at later; and then pulling out the next strand. It is not clear. It is not quick. And it is not neat. We are reverse-engineering: looking at the finished product, and then looking back to see what created it. And where I can work out how the rear wheels of my car are powered by simply looking at what they are connected to, the human personality is far more complex than this, with multiple connections to multiple events in the past, where events may well be connected to each other, and where other humans (i.e. complex variables) also become involved. Maybe we are more akin to spiders' webs, than cars, with the multiple, inter-linking strands connecting to form a whole web.